Should I stay or should I go? Patient understandings of and responses to source-isolation practices

Mary Wyer, School of Health Sciences, University of TasmaniaFollow
Rick Iedema, School of Health Sciences, University of Tasmania; Agency for Clinical Innovation (NSW Ministry of Health)Follow
Christine Jorm, Sydney Medical School, University of SydneyFollow
Gary Armstrong, Patient co-researcherFollow
Su-Yin Hor, School of Health Sciences, University of TasmaniaFollow
Claire Hooker, Centre for Values, Ethics and the Law in Medicine, University of SydneyFollow
Debra Jackson, Faculty of Health and Life Sciences, Oxford-Brookes University; School of Health, University of New EnglandFollow
Clarissa Hughes, School of Health Sciences, University of TasmaniaFollow
Matthew V.N. O'Sullivan, Centre for Infectious Diseases and Microbiology, Westmead Hospital; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of SydneyFollow
Gwendolyn L. Gilbert, Centre for Infectious Diseases and Microbiology, Westmead Hospital; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of SydneyFollow

Abstract

Isolation of patients, who are colonised or infected with a multidrug-resistant organism (source-isolation), is a common practice in most acute health-care settings, to prevent transmission to other patients. Efforts to improve the efficacy of source-isolation in hospitals focus on healthcare staff compliance with isolation precautions. In this article we examine patients’ awareness, understandings and observance of source-isolation practices and directives with a view to understanding better the roles patients play or could play in transmitting, or limiting transmission, of multidrug-resistant organisms (MRO). Seventeen source-isolated adult surgical patients and two relatives participated in video-reflexive ethnography and interviews. We learned that, although most of these patients wanted to protect themselves and others from colonisation/infection with a MRO, they had a limited understanding of what precautions they could take while in isolation and found it difficult to obtain ongoing information. Thus, many patients regularly left their source-isolation rooms without taking appropriate precautions and were potentially contributing to environmental contamination and transmission. Some patients also interacted with other patients and their personal belongings in ways that exposed other patients, unnecessarily, to colonisation/infection risk. By not providing patients with adequate information on infection risk or how they could contribute to their own safety or that of others, they are denied the opportunity to fully engage in their healthcare. To improve the efficacy of source-isolation and contact precautions in general, patient care providers should consider colonised or infected patients as active partners in reducing transmission and involve patients and relatives in regular, ongoing conversations about transmission prevention.

Recommended Citation

Wyer M, Iedema R, Jorm C, Armstrong G, Hor S, Hooker C, Jackson D, Hughes C, O'Sullivan MV, Gilbert GL. Should I stay or should I go? Patient understandings of and responses to source-isolation practices. Patient Experience Journal. 2015; 2(2):60-68. doi: 10.35680/2372-0247.1094.